What is school refusal?

School refusal is a complex psychological issue where a child or adolescent persistently avoids attending school due to emotional distress. It is not the same as truancy, as school-refusing children often communicate their difficulties to their parents and may even attempt to attend school before their anxiety or fear becomes overwhelming.

This condition is often associated with anxiety disorders, depression, or other underlying emotional issues. School refusal typically arises during transitional periods, such as starting a new school year, moving schools, or significant family changes.

Signs of school refusal

Identifying school refusal early is crucial for effective intervention. Key signs include:

• Frequent absenteeism: Repeated and unexplained absences or tardiness.
• Somatic complaints: Regular reports of headaches, stomach aches, or other physical symptoms, especially on school mornings.
• Emotional distress: Severe anxiety, crying, tantrums, or panic attacks when school attendance is imminent.
• Avoidance behaviours: Refusing to get dressed, leave the house, or enter the school premises.

These signs are often accompanied by academic decline and social isolation, which can exacerbate the issue if left unaddressed.

Causes and triggers of school refusal

School refusal often stems from a combination of personal and environmental factors. Common triggers include:

• Fear of failure or social rejection.
• Bullying or conflicts with peers.
• Academic pressures.
• Family issues, such as divorce or bereavement.

Treatment and support

Successful treatment for school refusal involves a collaborative approach involving parents, educators, and mental health professionals.

• Therapeutic interventions: Cognitive-behavioural therapy (CBT) is widely used to help children identify and manage their anxieties. Gradual exposure therapy can also encourage them to return to school settings.
• School-Based interventions: Schools can provide additional support through counsellors, modified schedules, or peer mentoring programmes to ease the child’s reintegration.
• Medication: In severe cases, anti-anxiety or antidepressant medications may be prescribed alongside therapy to manage underlying conditions.

How can parents support children experiencing school refusal?

Parents play a pivotal role in helping their children overcome school refusal. Providing a supportive and structured environment at home can alleviate the child’s anxiety and facilitate their return to school. Key strategies include:

• Open communication: Encourage your child to express their feelings without fear of judgement. Ask open-ended questions to understand their concerns and fears related to school. For instance, “What worries you the most about going to school?”
• Establish routines: Consistent morning and bedtime routines help create a sense of stability. Gradually preparing for school each day, even if the child doesn’t initially attend, reinforces a sense of normalcy.
• Positive reinforcement: Celebrate small victories, such as attending part of a school day or engaging in school-related activities. Avoid focusing on missed days, which can increase feelings of guilt or shame.
• Avoid enabling avoidance: While it’s natural to want to shield your child from distress, consistently allowing them to stay home can reinforce avoidance behaviours. Instead, work with your child and school to create a manageable plan for returning.
• Model Calmness: Children often take cues from their parents’ emotions. Remain calm and patient, even during setbacks, to help your child feel safe and supported.

Outcomes and prognosis

With timely and tailored interventions, many children overcome school refusal and resume regular attendance. However, a proactive and understanding approach is essential to prevent long-term academic or emotional setbacks.

By recognising the signs and addressing underlying causes, families and schools can work together to support children in overcoming school-related fears and fostering resilience.